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Recruiter's Glossary
Industry
Examples:
Exchange Plans
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Utilization Review
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Claims Adjudication
Health Insurance Terms
Understanding these terms will help you better evaluate candidates and communicate with hiring managers
HMO
Network Adequacy
Coordination of Benefits
EPO
POS
CPT Codes
Copayment
Capitation
Grievance Process
Group Coverage
Deductible
Claims Adjudication
Prior Authorization
Underwriting
ERISA
Medicaid
HIPAA
Stop Loss
Coinsurance
COBRA
Utilization Review
Mental Health Parity
Medical Loss Ratio
Formulary
UCR
Fee-for-Service
TPA
DRG
ACA
Out-of-Network
In-Network
Exchange Plans
Medicare
HCPCS
PPO
ICD-10
Premium
Individual Coverage
Provider Network
Value-Based Care
Risk Adjustment
EOB
Population Health
Appeals Process
MLR
Member Services
Disease Management
Care Management
Credentialing
Eligibility Verification
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